Monday, January 21, 2013

Jason's Birth Story

Jason at one week old, being a little human pupa.

I know I should be sleeping, but Jason is passed out, Jackson is with his grandparents, my boobs aren’t terribly engorged at the moment, and I’m worried I’ll forget even more if I delay this any longer, so...Jason’s birth story follows herewith:It was 29 degrees the morning we left for the hospital, which is about as cold as I’ve ever known it to get around here. We had an appointment for an induction at 40 weeks, 6 days at UCLA Ronald Reagan Hospital in Westwood. Doctors and midwives have been known to let post-due moms go to 42 weeks, but rates of spontaneous fetal death supposedly spike at that time, due to placental aging, and I couldn’t stand another week of waiting and worrying. Jackson was also induced, and born at 41 weeks, 1 day. I’d been measured at 3 centimeters dilated the week before, so I was considered to be a good candidate for an induction.Breakfast was McDonald’s drive-through, and then we dropped Jackson off at grandma and grandpa’s house with enough clothes and toys and books to keep him busy for a week if need be.We checked in at the hospital (“I’d like to have a baby, please”) and after checking to make sure my ID matched my appointment because apparently it’s historically been a thing that women without insurance borrow other womens’ identities to give birth under (who knew?), we were put into the good hands of Renae. Renae was our labor and delivery nurse and gosh was she the perfect match for me. Chatty and informative, we had a blast talking to her all morning. The intake questions take forever, and then we had the usual drama of getting a needle in me. They set you up with a little IV portal called a “saline lock” (formerly “hep lock”) but it’s not easy with my terrible veins. I’m totally cool with all the sticks (I used to give blood all the time), but it’s really hard to find a satisfactory vein so expert Danielle was called in. In the process I learned that your blood vessels have vents and flaps, just like your heart. I never knew that before, and I’m feeling a little lied-to by my third-grade human body book. Anyway, on the third attempt, we got a nice bleed going out of my left arm (I still have a heavy bruise on one hand from failed attempt two).Next, charisma-free resident Dr. E came in and did an ultrasound. She found that he was probably 3600 (grams?) or 8 pounds, that his head was normal-size, and that he was measuring at about 38 or 39 weeks, i.e. a regular old baby who probably wasn’t going to get stuck in the birth canal because he was a macroscopic and prone to shoulder dystocia or other complications.Awesome midwife Maria (aka “pregnant midwife”; 28 weeks along with her first!) came by to check and according to her exam, at that point I was still 3 cm, 60 percent effaced and close to -2 station. With that situation, they skip the Cervidil and go straight to a Pitocin drip. Midwife Maria: “Can we get her a room? If we’re giving her Pitocin, let’s at least get her a view.” Whee!The room was great, with a view over Westwood Blvd. and the UCLA campus. I spent a good part of the day watching palm trees blowing in the winter wind, which was a nice peaceful image to focus on.We checked in at 8:15 a.m., the Pitocin started running at 10 a.m. and I can honestly say that nothing much happened between 10 a.m. and 3 p.m. when my water was broken. For most of the morning, I chatted with the nurse and our lovely doula Jenny, repeated my whole obstetric medical history to hilariously insecure and young medical student Monica as part of her training (it is a teaching hospital after all), sipped the melty water in the bottom of my ice chips cup, waddled to the bathroom with cords and IV pole in tow (easily the most humiliating and irritating part of the entire birth process) and watched as my contractions rose and fell on the monitor (and yes, in my uterus).Oh, the monitors. I have some issues with the monitors, especially the fetal heart monitor. I just don’t think it’s that accurate, and it’s not merely a pain in the ass, it is literally a belt that straps you down to the bed. The monitors are surveillance and control, and they are a source of possibly unnecessary sturm und drang throughout the day. Every so often a nurse will slip in (sometimes strolling, sometimes flying in on high alert) and announce a “decel” and fuss with the monitors until the allegedly vanishing or diminishing heartbeat returns. Meanwhile, I strongly suspect that the external monitor is simply imperfect technology that measures maternal immobility more effectively than it measures fetal heart rates. Grrr...but if you have the induction, you have to have the monitors, and I like hospitals and modern medicine, so fine.At 3 p.m. I can’t remember where we were on Pitocin (I eventually got to level 5, at some point in the process), but I knew based on the irregularity and general pleasantness of my contractions that my body wasn’t going to pop out a baby any time soon. We could possibly noodle around for another day, or we could make the Pitocin drip work harder, which would probably lead to an epidural and still more time, so when Midwife Maria suggested breaking my water, I was all for it. I think my doula was horrified, but for some reason it just felt like the right thing to do.This was my first “water breaking” experience. It really does gush! Jackson had virtually no amniotic fluid around him (like, a .8 fluid measurement; Dr. Erin measured Jason as having an 11 fluid measurement) and my water never broke the first time around, so that was an interesting new aspect to the birth experience.Anyway, once my water was broken, we started really having a baby. Also, things start getting fuzzy, memory-wise, which I think is just proof of increasing labor intensity, so bear with me as the details get cloudier. Contractions became increasingly intense. I had to shift positions more often, flipping from side to side, although the best, by far, was standing leaning over the side of the bed set at its highest position. I leaked a little more fluid at one point, while heading to the bathroom--everyone swore it was amniotic fluid and not pee, and they were all delighted that it was clear, meaning no meconium or blood mixed in. I think I did a good job sounding through the contractions, which basically means lowing like a cow.I think the game changed around 5 p.m., because that’s when I remember thinking, “I want my mommy.” Hee. My doula and the nurse and Andrew were all great, but I think wanting your mommy is a signpost of a different kind of neediness. Maria came in about then and told me she’d probably be able to check me again at 6:30 or 7 p.m. and we’d know then how far gone I was.Anyway, at 5:30 p.m., I called my parents--twice, as the first call was interrupted by a contraction--and basically told them to relax and I’d see them later. At that point I was virtually certain that I would be contracting all night and I’d finally get an epidural when I couldn’t take the exhaustion any more and then we’d have a baby in the morning, just like last time. Sometime in here, I asked Andrew if he remembered “pelvic squeezes” which, along with heat packs, were the only thing that kept me from dying of sheer misery during back labor with Jackson. He came over and did one to get me through a contraction and I heard the doula say, “Are you feeling more pain in your back? The baby might be moving down.” I was past the point of wanting to chit-chat and had reverted to shrugging and grunting as my primary means of communication, so I didn’t respond, but in retrospect she was probably quite right.Around 6 p.m., I told Andrew to go to dinner since we obviously were going to be there for a while, but demanded a long “husband hug” from him on the way to the bathroom. I choose to sentimentally believe that it was the good hormones from the husband hug that kicked off the final phase of labor...While in the bathroom, I went through about five contractions in a row. Poor doula Jenny kept checking on me, but I was not having it. I am willing to give up basically all dignity in the process of birthin’ babies, but for some reason in the bathroom I feel like there should be a line: “This far and no farther!” She kept sticking her head in until finally I snapped, quietly, “Just go away!” Again, in retrospect, this mood shift is a total sign of transition to hard labor.I made it back in the room, where I promptly announced, “I’m going to start swearing now, if that’s OK with everybody.” And swear I did. There was screaming too. No more gentle cow lowing. Now, I’m not sure what tipped off everybody out in the hall that it was time--maybe it was something on the monitors, maybe it was the “Fuck fuck fuck, ow ow ow, aaaaah!” or maybe Renae just pressed a secret silent “pushing time” alarm--but that’s when the room started filling up. Dr. E appeared, and some nurses, and then Maria appeared and said, “Jen, I think you just turned a corner really quickly there. Get on the bed and let me check you.”At this point, I just have a series of disconnected images more than I have a story, so again, bear with me:Midwife Maria: “You’re fully dilated, it’s time to push.” (Seriously?)Doula Jenny: “Where’s Andrew? How can we reach Andrew?” (We found my phone and I called him and he raced up from the cafeteria.)I open my eyes to see about seven women in the room. I think that's when they turned on the medical spotlight and broke down the bed so it's more like a chair, and I saw various medical professionals fussing around the edges of the room, fiddling with the warming table and opening drawers.I’m given a series of instructions by a series of women I’ve never met before. Essentially, I’m meant to hold my legs back, bend over my belly, but don’t lift my butt off the table but do lift my chest up, and push, but only during the contraction, not otherwise. It looks and feels like a lot like dead bug/happy baby pose from yoga (but with your arms hooked behind your knees instead of grabbing your toes), and now that it’s over, I would like to point out that it’s completely anti-gravitational. You’ve got to push the baby up (over your tailbone) and out,but the inefficiency of the lithotomy position for birth has been addressed in great and extensive depth elsewhere so I'll just leave it at that. Suffice it say, I should have stayed in the bathroom and given birth on the toilet. Hee.Also, “Don’t scream.” There’s some reason screaming is bad or not ideal--it steals energy from the contraction I guess?--but step off, ladies, this hurts and it’s terrifying and I can’t imagine doing anything else.The next cluster of memories aren’t necessarily in the right order:Andrew appears beside the bed and I'm sooo happy to see him and he gives me just the right look of support and love and "Holy crap we're having a baby!," but there are now seven women surrounding me on all sides, so he’s back a bit. Later, during a particularly tough contraction I beckon him forward for hand-holding and they make room.Me yelling, repeatedly and oh so bravely: “Cut it out, suction it out, pull it out, I don’t care, just get it ooooout.” What? I was out of my head and I may have temporarily forgotten that it was my job to get him out. Heh.Midwife Maria: “Page Dr. So-and-So for possible vacuum delivery.” “Alert peds.”And then there were fifteen people in the room. Apparently the baby's heartrate declined or stopped or fell off the monitor or somesuch, and they were preparing for a rescue and resuscitation.Midwife Maria: “Jen, I’m going to have to cut an episiotomy.” (Me, in my head: “It’s about fucking time.”)*Midwife Maria: “Jen, push your baby out. This baby needs to come out now.” Various statements to this effect from surrounding experienced nurses, along with well-meaning advice about pushing techniques. Meanwhile, I’m just kind of out of my head and doing my best. I remember feeling one good push, but largely pushing is this wildly out-of-control experience and my internal response to most of the commands is “What does it look like I’m doing?!” or “I don’t know what you’re talking about or how to make that happen while I’m upside down, screaming, with three different women holding my legs and my crotch.”Midwife Maria: “Jen, reach down and feel your baby’s head.” Me, reaching down: Oh hey, that’s his wrinkly head down to his eyebrows at least. Cool, I guess I've been doing something here.At this point I was simultaneously panicked, annoyed and blithely unconcerned about the alleged heartrate thing, which on some instinctive level l knew wasn’t a real problem, but which was making everyone around me very tense and rushed. Get it out, get it out, get it out was the refrain in the room, from all of us. I was, however, wondering as the baby shifted his way out, “Is this the ring of fire? Was that it?” I’m not sure I ever felt one specific thing that qualified for a “perineal scream”--so you know, I just screamed throughout, which is apparently quite unhelpful, but hey, you do what you can.Midwife Maria announced “Compound arm” and maybe compound something else, in a tone that implied that that explained something.

Finally, more screaming, more pushing, and a baby popped out!I saw him the first second he was out, and he cried out heartily the second after that (see, I told you he was fine) and then they whisked him away so the pediatric ladies had something to do, and I watched across the room as Andrew watched over him, smiling.APGAR scores were 8 and 9, and he latched on almost immediately. He was 7 lbs 9 oz at birth, and 20.5 inches, i.e. slightly longer and skinnier than his brother. Postpartum stuff happened too, but there’s no glamour in that, so this is probably enough detail for now. *I would like to apologize to the wonderful UCLA Midwives practices for again dinging your overall 1% episiotomy rates. I know you never do them but I appreciate you making an exception for me (twice now) and getting my babies out safe both times. You guys are wonderful.tl;dr: Jason Godwin Arrow was born Monday, January 14 at 6:30 p.m. after eight and a half hours of labor (look ma, no epidural!) and we are just delighted to have him.